If upheld, Obamacare will change American social contract

In this March 23, 2010 file photo, President Barack Obama signs the health care bill, in the East Room of the White House in Washington. Tackling a huge logistical challenge, the Obama administration Monday released an ambitious blueprint for states to match up uninsured Americans with coverage that's right for them under the health care overhaul law. The long-awaited regulation, released as the Supreme Court prepares to hear a challenge to the law, stresses state and federal flexibility.

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Obamacare dominated the 2010 midterms, driving its Democratic authors to a historic electoral shellacking. But since then, the issue has slipped quietly underground.

Now it's back, summoned to the national stage by the confluence of three disparate events: the release of new Congressional Budget Office cost estimates, the approach of Supreme Court hearings on the law's constitutionality and the issuance of a compulsory contraception mandate.

Cost: Obamacare was carefully constructed to manipulate the standard 10-year cost projections of the CBO. Because benefits would not fully kick in for four years, President Obama could trumpet 10-year gross costs of less than $1 trillion — $938 billion to be exact.

But now that the near-costless years have elapsed, the true 10-year price tag comes into focus. From 2013 through 2022, the CBO reports, the costs of Obamacare come to $1.76 trillion.

Annual gross costs after 2021 are more than a quarter of $1 trillion every year. That, for a new entitlement in a country already drowning in $16 trillion of debt.

Constitutionality: Beginning Monday, the Supreme Court will hear challenges to the law. The American people, by a two-thirds majority, want the law and/or the individual mandate tossed out. In practice, however, questions this momentous are generally decided 5 to 4, i.e., they depend on whatever side of the bed Justice Anthony Kennedy gets out of that morning.

Ultimately, the question will hinge on whether the commerce clause has any limits. If the federal government can compel a private citizen, under threat of a federally imposed penalty, to buy health insurance, is there anything the federal government cannot compel the citizen to do?

If Obamacare is upheld, it means the end of a government of enumerated powers — i.e., finite, delineated powers beyond which the government may not go, beyond which lies the free realm of the people and their voluntary institutions.

Coerciveness: Serendipitously, the regulation on contraceptive coverage has allowed us to see exactly how this new power works. All institutions — excepting only churches, but not excepting church-run charities, hospitals, etc. — will be required to offer health care that must include free contraception, sterilization and drugs that cause abortion.

Consider the cascade of arbitrary bureaucratic decisions that resulted in this edict:

(1) Contraception, sterilization and abortion pills are classified as medical prevention. But surely categorizing pregnancy as a disease equivalent is a value decision. If contraception is prevention, what are fertility clinics? Disease inducers? And if contraception is prevention because it lessens morbidity and saves money, by that logic, mass sterilization would be the greatest boon to public health since the pasteurization of milk.

(2) This type of prevention is free — no co-pay. Why? Is contraception morally superior to or more socially vital than — and thus more of a “right” than — penicillin for a child with pneumonia?

(3) “Religious” exemptions to this edict extend only to churches, places where the faithful worship God, and not to church-run hospitals and charities, places where the faithful do God's work. Who promulgated this definition, so subversive of the whole notion of godliness, so stunningly ignorant of the very idea of religious vocation? The almighty HHS secretary.

Rarely has one law so exemplified the worst of the Leviathan state — grotesque cost, questionable constitutionality and arbitrary bureaucratic coerciveness. Little wonder the president barely mentioned it in his latest State of the Union address. He wants to be re-elected. He'd rather talk about other things.

But there's no escaping it now. Oral arguments begin Monday at 10 a.m.